1. Technical Field
The present disclosure relates generally to a device, a system, and a method of electrosurgery and, more particularly, to a method and device adapted for single incision laparoscopic surgery (SILS) to maximize the manipulability of electrosurgical instruments used during a SILS procedure.
2. Background
Two popular electrosurgical techniques are monopolar electrosurgery and bipolar electrosurgery. Monopolar electrosurgical techniques deliver alternating current electrosurgical energy from an exposed or an active electrode, through the patient's body, to a return pad or an electrode which is externally attached to a suitable location on the patient's skin. Bipolar electrosurgical methods deliver electrosurgical energy from a first exposed electrode in which both the first and the second electrodes are typically disposed within the patient's body, for example, the opposing jaws of electrosurgical forceps.
Electrosurgical instruments are devices that deliver radio-frequency (RF) energy to a tissue site, such as an electrosurgical instrument. The term “electrosurgical instrument,” as used herein, is intended to include instruments having a hand-piece attached to an active electrode and used to cauterize, coagulate, and/or cut tissue. Typically, the electrosurgical instrument may be operated by a hand-switch or a foot switch, and are hand-held.
The waveforms produced by the RF source may yield a predetermined electrosurgical effect such as electrosurgical cutting, blending, or coagulation. Coagulation is defined as a process of desiccating tissue, wherein the tissue cells are ruptured and dehydrated. Electrosurgical cutting and dissecting include the application of electrosurgical energy to tissue to produce a cutting, dissecting, and/or dividing effect. Blending includes the function of cutting (dissecting) with the production of a hemostasis effect. Hemostasis is defined as the process of liquefying tissue collagen so that it becomes a fused mass.
The active electrode is an electrically conducting element, which is usually enlongated and may be in the form of a thin blade with a pointed or rounded distal end. Alternatively, the active electrode can include an enlongated narrow cylindrical needle that is either solid or hollow with a flat, rounded, pointed, or slanted distal end. The hand-piece of the electrosurgical instrument is connected to a suitable electrosurgical energy source (generator) that produces the RF energy needed for the operation of the electrosurgical instrument. In general, when performing an operation with an electrosurgical instrument, electrical energy from the electrosurgical generator is conducted through the active electrode to the tissue at the site of the operation and then through the patient to a return electrode. The return electrode is selectively placed on the patient's body and attached to the generator by a conductive material.
One technique for electrosurgery, called single incision laparoscopic surgery (SILS), reduces scanning and accelerates healing. The SILS technique involves making one single small incision, instead of several, through which a surgeon operates. Typically, the surgery is performed around the umbilicus (belly button) area. Fewer incisions result in a faster recovery with less pain.
Within the single incision, typically three or four ports are placed for the insertion of electrosurgical instruments to the operative field. Usually, two or three ports are used for devices having a 5 mm diameter and at least one larger port having a 10 to 12 mm diameter to allow for the insertion of an endoscope. Since all the channels are parallel to one another within a single incision, the instrument handles often line up and interfere with each other. This problem may be offset somewhat by making a larger incision in the patient with the resultant delay in healing and increased scarring.